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【medical-news】特发性肺纤维化病人的 680英尺
Shorter distance on six-minute walk test points up a greater risk of death
For idiopathic pulmonary fibrosis (IPF) patients awaiting lung transplantation, a simple walk test can predict mortality rates. A new study found that individuals with IPF who can cover less than 680 feet during the six-minute test are four times more likely to die than those who can walk greater distances.
The research appears in the second issue for September 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
David J. Lederer, M.D., of the Division of Pulmonary, Allergy and Critical Care Medicine at Columbia University College of Physicians and Surgeons in New York City, and five associates examined the records of 454 adult IPF patients on U.S. transplantation waiting lists.
In IPF, lung tissue is damaged by an unknown cause. The walls of the air sacs become inflamed, which leads to scarring or fibrosis. As a result, patients with IPF frequently suffer from progressive respiratory failure. Eventually, the scarring causes permanent loss of the lungs' ability to transport oxygen.
To date, lung transplantation is the only medical therapy that has been shown to improve survival. Twenty-percent of all lung transplant procedures performed worldwide involve patients with IPF.
The investigators call the six-minute walk test a "simple, safe, reliable and inexpensive" way to assess the self-paced exercise capacity of IPF patients. It varies little when repeated on the same person over a short period of time.
"A total of 209 patients had a six-month follow-up without undergoing lung transplantation," said Dr. Lederer. "Forty-nine of these patients, 23 percent, died during that time period. The six-minute walk test's ability to separate those alive at six months from those who died was not only significantly better than chance, but also superior to the forced vital capacity percent (FVC%) predicted test."
The authors noted that a lower six-minute walking distance was associated with more severe lung disease, status as a minority and lower educational attainment in a nationwide cohort of patients with IPF who were listed for lung transplantation.
The test also predicted waitlist mortality independently of age, sex, race, lung function indices, presence of pulmonary hypertension and other potential confounders.
According to the investigators, the six-minute walk test has at least four advantages over other tests: 1) it is less costly than other tools; 2) it can be performed on patients with severe hypoxemia (inadequate amounts of oxygen in the blood) who require continuous high-flow oxygen; 3) it can be performed in any sufficiently long hallway by appropriately trained personnel; and 4) it does not require specialized equipment and expertise found only in established pulmonary function laboratories;
The authors concluded that a test like FVC% predicted might not be valid for gauging survival in patients with IPF who have been listed for lung transplantation because of the serious nature of their illness. 认领了 六分钟行走距离的缩短意味着死亡危险的增加
对于等待接受肺移植的特发性肺纤维化（IPF）患者，一种简单的行走测试就能够预测其死亡率。一个新的研究发现在IPF患者，那些在6分钟内行走距离少于680英尺的人死亡率比那些能行走更长距离的人高出4倍。
这项研究发表在美国胸科学会出版的《美国呼吸道与危重症监护医学杂志》2006年9月第2期上。
纽约市哥伦比亚大学内外科医生学院肺、变态反应和重症监护医学区医学博士David J. Lederer与其他5名同事一起检查了美国待移植患者名单中454例成人IPF患者的记录。
在IPF，肺组织损害原因不明。肺泡壁发生炎症反应，导致瘢痕化或纤维化。结果IPF患者发生进行性呼吸衰竭。最终瘢痕化导致肺运送氧的能力永久丧失。
迄今为止，肺移植是提高存活率的唯一的医疗治疗手段。全世界进行的肺移植手术中有20%为IPF患者。
研究者们称6分钟行走测试是一个“简单，安全，可靠和价格低廉”的评估IPF患者自我行走运动能力的方法。对同一个患者在短期内进行重复测试结果偏差很小。
Lederer博士说：“共有209名未进行肺部移植的患者进行了6个月的随访。这些患者中有49人，占总人数的23%，在此期间死亡。6分钟行走测试在区分6个月后患者是否存活的能力非常显著，而且优于最大肺活量百分数预测试验。”
作者指出，在全国进行肺移植登记名单的IPF患者人群调查中，6分钟行走的距离变短往往与严重的肺部疾患，少数民族和低教育水平相关。
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作者:admin@医学,生命科学 2011-08-29 05:11
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